This application requests a Mentored Patient-Oriented Research Career Development Award (K23) to study and evaluate ways to overcome barriers to treatment of depression in the elderly. The applicant is a Doctor of Pharmacy specializing in the pharmacotherapy of psychiatric disorders at Tufts New England Medical Center who proposes to develop research skills for treatment of depression in community dwelling elderly patients. Although major depression is widely recognized to cause significant morbidity and mortality in the geriatric population, the ever increasing population of community dwelling elderly are at particular risk of having recognized and unrecognized depression. Even in those with diagnosed depression, willingness to take antidepressant medications is suboptimal. Little is known about what the barriers to treatment are, and how these barriers may be overcome. The candidate's research and educational plan will focus on innovative research methodology including: a) advanced study design and statistical methodology to develop skills to address complex problems relevant to medication adherence assessment, b) qualitative research methods that permit exploration and definition of research questions regarding medication adherence behaviors, and c) mentored, integrated and interdisciplinary research experience under Tufts faculty in health services research, psychiatry, medicine, health policy and geriatrics. To achieve these goals, the candidate will compare trends in antidepressant (AD) use over time using data from an NIMH study of a longitudinal pharmacist intervention in depressed primary care patients. Second, explore reasons why depressed patients refuse to take AD treatment as prescribed in this cohort. Lastly, develop assessment tools to evaluate willingness to take AD medications in an NIA funded cohort of home bound elderly and an patients of an inner city geriatrics ambulatory care practice. The specific aims of the proposed research are: 1) to determine if reasons for not taking antidepressant medications as prescribed are different in the elderly compared with young adults; 2) to evaluate how and why community dwelling elderly refuse to take antidepressant treatment as prescribed. This research has potential to improve treatment of depression in the elderly, improve outcomes, quality of life and functioning to enable older individuals to maintain their independence outside an institutional setting.